A Novel and Practical Screening Tool for the Detection of Silent Myocardial Infarction in Patients With Type 2 Diabetes

Abstract

Objective:Silent myocardial infarction (MI) is a prevalent finding in patients with type 2 diabetes and is associated with significant mortality and morbidity. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) is the most validated technique for detection of silent MI, but is time-consuming, costly, and requires administration of intravenous contrast. We therefore planned to develop a simple and low-cost population screening tool to identify those at highest risk of silent MI validated against the CMR reference standard.Methods:A total of 100 asymptomatic patients with type 2 diabetes underwent electrocardiogram (ECG), echocardiography, biomarker assessment, and CMR at 3.0T including assessment of left ventricular ejection fraction and LGE. Global longitudinal strain from two- and four-chamber cines was measured using feature tracking.Results:A total of 17/100 patients with no history of cardiovascular disease had silent MI defined by LGE in an infarct pattern on CMR. Only four patients with silent MI had Q waves on ECG. Patients with silent MI were older (65 vs 60, P = .05), had lower E/A ratio (0.75 vs 0.89, P = .004), lower GLS (–15.2% vs –17.7%, P = .004), and higher amino-terminal pro brain natriuretic peptide (106 ng/L vs 52 ng/L, P = .003). A combined risk score derived from these four factors had an area under the receiver operating characteristic curve of 0.823 (0.734–0.892), P < .0001. A score of more than 3/5 had 82% sensitivity and 72% specificity for silent MI.Conclusions:Using measures that can be derived in an outpatient clinic setting, we have developed a novel screening tool for the detection of silent MI in type 2 diabetes. The screening tool had significantly superior diagnostic accuracy than current ECG criteria for the detection of silent MI in asymptomatic patients.

The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction

“…It has shown potential in terms of prognostication and has been demonstrated to be superior to LVEF in predicting morbidity and mortality in patients with IHD [ 26 ]. Additionally, it shows promise as a potential screening tool for silent MI [ 27 ].…”

Diabetes Mellitus, Microalbuminuria, and Subclinical Cardiac Disease: Identification and Monitoring of Individuals at Risk of Heart Failure

“…Cine images covering the entire heart in the LV short axis (slice thickness 10 mm); left atrium in short axis (slice thickness 5 mm) and in orthogonal long axis planes was acquired. Late gadolinium enhancement (LGE) in matching LV short‐ and long‐axis planes was carried out more than 6 minutes after rest perfusion imaging as described previously …”

“…In addition, several cardiovascular imaging methods have been used to show that type 2 diabetes mellitus is associated with increased rates of CAD, silent myocardial ischemia, and silent myocardial infarction (MI) . Patients with type 2 diabetes mellitus have elevated levels of cardiac biomarkers including high‐sensitivity cardiac troponin T (hs‐cTnT) and amino terminal B type natriuretic peptide (NT‐proBNP), which appear to be associated with adverse cardiovascular outcomes including heart failure …”

Distinct non-ischemic myocardial late gadolinium enhancement lesions in patients with type 2 diabetes

“…Previous LGE CMR studies in T2DM populations have focused on ischemic heart disease with ischemic LGE lesions from myocardial infarctions (14)(15)(16). Of interest, we found a lower prevalence of unrecognised myocardial infarcts than in previously examined T2DM cohorts (16) This could be due to different study populations but it is also likely that due to modern treatment of risk factors for ischemic heart disease in T2DM, T2DM populations now reach higher age. Perhaps therefore the non-ischemic brotic lesions were more prevalent than unrecognised myocardial infarcts.…”